Scores of North Jersey patients were betrayed by their doctors and left with bogus diagnoses in their medical files as a result of a widespread cash-for-referrals scheme that generated tens of millions of dollars in profits for a Parsippany-based diagnostic lab.

The long-running scheme involving “numerous” doctors in New Jersey bilked millions of dollars from Medicare and private health insurers, betrayed the trust of patients and could lead to future problems for patients whose medical records were doctored with fabricated diagnosis codes to justify ordering unnecessary blood tests, said U.S. Attorney Paul J. Fishman, who announced charges Tuesday against four people.

Among them was Dr. Frank Santangelo, an internist with offices in Wayne and Montville, who allegedly received more than $700,000 in bribes for referring at least $4.2 million in blood tests to Biodiagnostic Laboratory Services LLC. Santangelo, 43, of Boonton, also was charged with using the mails and facilities in interstate commerce to promote commercial bribery.

Capping a multiyear investigation that involved the cooperation of two unnamed doctors, federal agents also arrested David Nicoll, 39, of Mountain Lakes, Biodiagnostic Laboratory Services president and a part-owner of the company. Profits from the conspiracy allegedly fueled Nicoll’s multimillion-dollar purchase of high-end collectible cars, a Manhattan apartment and private jet travel, among other lavish expenses.

A criminal complaint charges Nicoll, his brother, Scott Nicoll, 32, of Wayne, their cousin Craig Nordman, 34, of Hanover Township, and the company with conspiring to bribe physicians from January 2006 to this year.

The four men appeared in shackles before U.S. Magistrate Judge Madeline Cox Arleo, who ordered their release on bail of $1 million for David Nicoll, $500,000 for his brother, and $250,000 each for Nordman and Santangelo.

To carry out the scheme and disguise their illicit payments, the conspirators allegedly used “sham” rental, service and consulting agreements to funnel bribes to doctors to induce them to refer patient blood samples to the lab and to get them to order unnecessary tests, the complaint charges.

Under the lease and service agreements, doctors were paid thousands of dollars a month for space in their medical offices that the company didn’t need or use to perform routine blood drawing services.

In a 2009 exchange of text messages cited in the complaint, David Nicoll complained to Santangelo that the company “really can’t afford the 40-50,000 [dollars] a month if the girls aren’t going to be drawing any blood,” and Santangelo replied, “U no u can count on me! I’ll never let you down!”

Fishman said that patients whose doctors participated in the scheme may not realize their medical records have been permanently compromised.

“What’s going to happen, for those patients, is somewhere in their charts in that doctor’s office and somewhere in the Medicare coding, and somewhere in the insurance reimbursements that are coming from private insurers, it’s going to reflect that that patient got a diagnosis to justify that blood test that might not actually be right,” he said. That could present a danger of misdiagnosis for patients in the future, he said.

“That diagnosis will live in that medical record as long as that patient is alive, and that’s a problem,” Fishman said.

At the Hamburg Turnpike office building where Santangelo has his Wayne practice, a patient who identified himself only as John B. said that he and family members once were patients of Santangelo’s but switched to other local doctors after a number of misdiagnoses. He said Santangelo prescribed his mother thyroid medication when she had no thyroid problem, and that his cousin was incorrectly told that he had cancer.

“The only reason I came back is because I heard there was a new doctor working here,” he said.

Most patients said they were unaware of the charges against their doctor. One woman said she was happy with Santangelo.

“God bless him,” she said as she walked into the office.

When New Jersey banned lease and service agreements between blood labs and doctors in a crackdown on bribes for referrals in 2010, the Nicoll brothers and Nordman created and funded at least six new entities “to funnel the bribes to doctors as phony consulting fees,” Fishman said.

In a series of recorded conversations, Nordman allegedly told a cooperating doctor that a company-funded entity called Advantech had engaged other physicians as consultants in order to continue the payments it could no longer make directly and to induce them to increase the number of tests ordered for their patients, the complaint said.

The investigation was aided by the cooperation of two company employees and two doctors, all of whom have agreed to plead guilty, authorities said.

Fishman said investigators have yet to pinpoint exactly how many of the doctors who sent blood work to BLS were being bribed, “but we suspect it was the vast majority.”

From 2006 to 2012, the company had revenue of more than $200 million from the testing of blood and related services, providing David Nicoll with distributions of more than $33 million, the complaint said.

He spent more than $5 million on collectible automobiles, including $580,000 for a Yenko Nova and $360,000 for a Yenko Chevelle, $300,000 for a Ferrari, and $291,000 for a Corvette. He also spent more than $700,000 to buy a Manhattan apartment for a female companion, $600,000 on private jet charters, $392,000 on tickets to sporting events, $216,000 at electronics stores, and $154,000 at a gentleman’s club/restaurant, the complaint said.

“By paying illegal kickbacks to doctors, BLS put money between doctors and their oath to provide unbiased guidance to their patients,” Fishman said.

“Fraud isn’t just a drain on the Medicare or Medicaid program,” Fishman added. “It drives up the price all Americans must pay for health care, and even worse, it compromises the safety and health of patients.

The investigation was conducted by the FBI, the Internal Revenue Service, the Postal Inspection Service and the Health and Human Services Office of the Inspector General.